Early control of the distal internal carotid artery during endarterectomy: Achievability and results
Early control of the distal internal carotid artery during endarterectomy: Achievability and results
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DOI：
10.1067/mva.2002.122028
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发表时间：
2002-07-01
影响因子：
4.3
通讯作者：
Crimmins, DS
中科院分区：
文献类型：
--
作者：
Bourke, BM;Crimmins, DS
目的：本研究的目的是报告一系列连续的颈动脉内膜切除术（CEA）的结果，由一名外科医生进行，并由一名神经科医生独立评估，其中前瞻性地记录了选择性早期控制远端颈内动脉（伊卡）的可行性。方法：所有在1999年11月17日至2001年11月15日期间接受手术作者CEA的患者，进入一项前瞻性研究，在此期间，尝试早期选择性暴露和夹闭远端伊卡（最初避免颈动脉分叉暴露和回缩），这允许在伊卡夹保护和抗凝治疗的情况下进行手术的剩余部分（未进行分流的患者）。所有手术均在颈部局部阻滞麻醉下进行，所有患者均接受静脉补片手术，除一例患者外，未使用脑血管造影术。主要发病率（中风和心肌梗死），死亡率和连续性独立验证由神经学家。在142例（96%）病例中，最初可以分离和控制ICA远端软伊卡，而无需剥离斑块承载球分叉区（A组），在其余6例病例中，必须暴露颈动脉分叉并回缩以允许伊卡夹闭（B组）。15例病例（A组14例，13组1例）需要分流术，剩下128例（86%）病例可以在伊卡夹闭和bra-in理论上防止颗粒斑块栓塞的情况下进行手术。有没有中风或死亡，一名患者有暂时性椎基底动脉缺血，一名患者有心肌梗死，一名患者有暂时性副神经麻痹，一名患者返回手术室释放颈部血肿，94%的术后一晚在hospital.Conclusion：早期选择性远端伊卡控制是高度可实现的CEA过程中，没有明显影响临床结果。当使用不需要对颈总动脉和颈外动脉进行初始控制的选择性分流方法（例如，局部颈部阻滞麻醉、脑电图/其他监测）时，其使用是相关的。建议进一步评价经颅多普勒扫描监测，以证实这种方法在减少或消除颗粒斑块栓塞的理论潜力。
Purpose: The purpose of this study was the report of the results of a consecutive series of carotid endarterectomy (CEA), performed by one surgeon and independently assessed by a neurologist, in which the achievability of selective early control of the distal internal carotid artery (ICA) was prospectively recorded.Methods: All patients who underwent CEA by the surgical author between November 17, 1999, and November 15, 2001, were entered into a prospective study during which early selective exposure and clamping of the distal ICA were attempted (with initial avoidance of carotid bifurcation exposure and retraction), which allowed die remainder of the procedure (in patients without shunting) to be performed with ICA clamp protection and anticoagulation therapy. All the procedures were performed with local cervical block anesthesia, all the patients under-went a vein patch procedure, and, with one exception, cerebral angiography was not used. Major morbidity (stroke and myocardial infarction), mortality, and consecutiveness were independently verified by a neurologist.Results: 148 consecutive CEAs were performed. In 142 cases (96%), the soft distal ICA could be initially isolated and controlled without dissection of the plaque-bearing bulb bifurcation area (group A), and in the remaining six cases, the carotid bifurcation had to be exposed and retracted to allow ICA clamping (group B). A shunt was needed in 15 cases (14 in group A, one in group 13), which left 128 cases (86%) in which the procedure could be performed with the ICA clamped and the bra-in theoretically protected from particulate plaque embolism. There were no strokes or deaths, one patient had temporary vertebrobasilar ischemia, one patient had a myocardial infarct, one patient had a temporary accessory nerve palsy, one patient returned to the operating room for release of a cervical hematoma, and 94% spent one postoperative night in the hospital.Conclusion: Early selective distal ICA control is highly achievable during CEA without apparently compromising clinical results. Its use is relevant when selective methods of shunting that do not need initial control of the common and external carotid arteries (eg, local cervical block anesthesia, electroencephalography/other monitoring) are used. Further evaluation with transcranial Doppler scan monitoring is suggested to substantiate the theoretic potential of this method in the reduction or elimination of particulate plaque embolism.